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EUSTACHIAN TUBAL INSUFFICIENCY
Aetiology
© Bruce Black MD
Anatomy of the Eustachian tube. Dysfunction may arise from the cartilaginous section, particularly with PNS
pathology, or the osseous section (middle ear disease). © Bruce Black MD
The middle ear. The site is similar to a watch with a dial (pars tensa) mechanisms (ossicles) and spring (cochlea),
the site is optimally functional only if well aerated. © Bruce Black MD
Tubal function 1. The tube opens upon deglutition, permitting the replenishment of air in the middle ear that
gradually absorbs into the bloodstream. © Bruce Black MD
Tubal dysfunction 2. Failure to replace the continual absorption of middle ear air results in a partial vacuum in
the middle ear cleft, causing drum retraction. © Bruce Black MD
Eustachian dysfunction 3. Prolonged tubal occlusion results in an effusion filling the middle ear cleft as air is
progressively reabsorbed. © Bruce Black MD
Normal tubal function. The tubal orifice (et) is opened during deglutition, as the tensor palati (tp) pulls around the pterygoid hamulus (ph). tc: tubal cartilage sp: soft palate. © Bruce Black MD
Effect of a cleft palate. Dehiscence of the midline raphe eliminates the lower anchor point of the tensor palati
traction on the tube, which then fails to open. © Bruce Black MD
Bifid uvula. This may be associated with a sub-mucosal cleft of the palatal musculature, causing tubal insufficiency.
© Bruce Black MD
Hare lip repair. Beware an associated palate cleft if managing tubal insufficiency.
© Bruce Black MD
Hare lip repair, associated cleft palate, cholesteatoma.
© Bruce Black MD
Cleft palate. Long history of middle ear effusions and repeated vent tube insertions.
© Bruce Black MD
Past cleft palate repair. Bilateral marked adhesive otitis.
© Bruce Black MD
Complications of Eustachian tubal failure.
© Bruce Black MD
“Goldfish Syndrome”: chronic juvenile mouth-breathing due to hypertrophied adenoids. Concurrent middle ear effusions
are common. © Bruce Black MD
Adenoidal hypertrophy causing chronic mouth-breathing and bilateral middle ear effusions. Protruding auricles.
© Bruce Black MD
Bilateral tubal insufficiency. Large tonsils, adenoids similarly enlarged and infected.
© Bruce Black MD
Plain film, lateral post-nasal space, showing total occlusion of the posterior nasal airway due to adenoidal hypertrophy.
© Bruce Black MD
A large adenoid pad touching on the soft palate. Chronic infection and tubal problems likely.
© Bruce Black MD
Total PNS occlusion by a large adenoid pad.
© Bruce Black MD
Deflected nasal septum, chronic right Eustachian insufficiency due to tubal blockage.
© Bruce Black MD
Coronal CT of the previous case sinuses. Septal deflection occluding the right nasal passage.
© Bruce Black MD
Giant haemangioma of the PNS with palatal extension. Palatal dysfunction resulted in tubal insufficiency.
© Bruce Black MD
Atopic dermatitis. Nasal allergy and Eustachian tubal problems commonly co-exist.
© Bruce Black MD
The dry and excoriated skin of chronic atopic dermatitis Chronic tubal problems may result from persistent nasal
allergy and infection. © Bruce Black MD
Lymphoma of the post-nasal space, secondary middle ear effusion. The tumour mass can be glimpsed beyond the soft
palate. © Bruce Black MD
Previous case, catheter retraction of the soft palate revealing the bulk of the tumour mass.
© Bruce Black MD
Carcinoma of the PNS, mirror view. Concurrent effusions. A common problem in southern China; beware the deafness
and an ipsilateral neck mass in this group. © Bruce Black MD
Carcinoma of the right PNS axial MRI view. Common in cases of south Chinese ancestry.
© Bruce Black MD
Carcinoma, Rt PNS, film showing a substantial soft tissue mass at the nasal end of the Eustachian tube, Partial
deafness and effusion, Rt. neck mass. Chinese ancestry. © Bruce Black MD
A large PNS carcinoma eroding the pterygoid plates to the left, and impinging on the airway. Middle ear effusion
present . © Bruce Black MD
Right middle ear effusion. The moderately extensive air cell system is opacified compared to the aerated left side.
© Bruce Black MD
Chronic tubal insufficiency on the left. The cell system is under-developed when compared with the contralateral well
aerated system. An effusion fills the middle ear. © Bruce Black MD
Chronic Right tubal failure. The mastoid cells are lesser developed and opaque compared with the normal left
system. © Bruce Black MD
Coronal view of the previous case. Underdeveloped and opacified Rt mastoid air cell system.
© Bruce Black MD